This course explains how insurers, insurance adjusters, and insurance special investigation unit investigators work to prevent insurance fraud (obtaining funds from an insurer wrongfully and illicitly). It explains staged losses, fake thefts, paper property, arson for profit, false documentation, and other efforts to defraud an insurer.  The course also explains what is necessary to prove fraud as a defense to an insurance claim. 

The course covers the following:

  1. The use of investigators to gather evidence establishing that a fraud is being attempted.
  2. The various types of fraud attempted against first party property policies.
  3. Understanding the staged accident.
  4. Understanding the use of paper property.
  5. How to discover an arson for profit.
  6. How to prove that an insured is involved in an arson for profit.
  7. How to discover health insurance fraud.
  8. How to recognize professional conspiracies.
  9. How to recognize fraud in the legal profession.
  10. How to act in good faith and fair dealing with regard to insurance fraud.
Learning Objectives
  • Explore how the fraud perpetrator’s use of the covenant of good faith and fair dealing to defeat insurer’s claim of attempted insurance fraud.
  • Recognize the elements insurance fraud and the proof needed to assert fraud as a defense.
  • Identify what investigation will be performed to stop fraud.
  • Explore how the statutory requirement to thoroughly investigate potential fraud makes successful fraud difficult.

 

 

 

Last updated/reviewed: January 17, 2023

Included In Certifications

This course is included in the following Certification Programs:

16 CoursesCorporate Property Insurance Certification

  1. Introduction: Excellence in Claims Handling
  2. How to Acquire a First-Party Property Insurance Policy
  3. How to Read and Understand an Insurance Policy
  4. The Necessity of an Honest and Complete Insurance Application
  5. The Basics of the Law of Contracts for the Insurance Professional
  6. Ethics for the Insurance Professional
  7. What is the Problem with Fraud?
  8. Interviewing Techniques for the Insurance Professional
  9. Investigation of a First-Party Property Insurance Claim
  10. The Creation of a Scope, Statement, and Proof of Loss
  11. The Duties of an Insured Presenting a First-Party Property Claim
  12. The Insurance Examination under Oath (EUO)
  13. Insurance Fraud Prevention
  14. Compliance with Special Investigation Unit Regulations
  15. Compliance with Good Faith Settlement Practices Regulations
  16. The Obligations of a Public Insurance Adjuster
2 Reviews (10 ratings)

Reviews

5
Member's Profile
This course was very clear and concise. A good review of how insurance fraud is handled
5
Member's Profile
Very easy course to get that last hour of CPE needed to renew.
Prerequisites
Course Complexity: Intermediate

No Advanced Preparation or Prerequisites are not needed for this course. However, it is recommended to take the other courses in the series prior to completing this one.

Education Provider Information
Company: Illumeo, Inc., 75 East Santa Clara St., Suite 1215, San Jose, CA 95113
Contact: For more information regarding this course, including complaint and cancellation policies, please contact our offices at (408) 400- 3993 or send an e-mail to .
Instructor for this course
  Course Overview CPE
Course Syllabus
INTRODUCTION AND OVERVIEW
  Introduction to Insurance Fraud Prevention10:33
  Types of Insurance Fraud10:54
  Insurance Claims Handling and Insurance Fraud1:38
  The Covenant of Good Faith & Fair Dealing and Its Effect on Insurance Fraud Investigations2:08
  When Insurance Fraud is Suspected in a First Party Property Claim10:48
  The First Party Property Claim and Insurance Fraud10:34
  The First Party Property Claim9:05
  The Philosophy of Denial of a Fraudulent Claim4:35
CONTINUOUS PLAY
  Insurance Fraud Prevention1:00:15
SUPPORTING MATERIALS
  Slides: Insurance Fraud PreventionPDF
  Insurance Fraud Prevention GlossaryPDF
REVIEW AND TEST
  REVIEW QUESTIONSquiz
 FINAL EXAMexam